Provider Demographics
NPI:1699013524
Name:BRENDON CONNOLLY, MD PL
Entity Type:Organization
Organization Name:BRENDON CONNOLLY, MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-342-6505
Mailing Address - Street 1:2001 MANATEE AVE E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1620
Mailing Address - Country:US
Mailing Address - Phone:941-757-3521
Mailing Address - Fax:941-714-0869
Practice Address - Street 1:2001 MANATEE AVE E
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1620
Practice Address - Country:US
Practice Address - Phone:941-757-3521
Practice Address - Fax:941-714-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty